An unusual course of SARS-CoV-2 infection: Challenging diagnosis of Guillain-Barré Syndrome.

COVID-19, caused by severe acute respiratory syndrome coronavirus-2, typically presents with respiratory symptoms and fever, but still a variety of clinical presentations have been reported. In this study, it was aimed to report a case of COVID-19 with an atypical presentation and an atypical course. As well, the recovery phase was complicated with GBS and consequently cytomegalovirus infection. It should be kept in mind that patients with COVID-19 severe disease need to be followed for neurological and other complications which may arise during the course of critical illness.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units.

BACKGROUND: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. AIMS: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. STUDY DESIGN: Retrospective, observational cohort. METHODS: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. RESULTS: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050). CONCLUSION: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Successful treatment of COVID-19 infection in a patient with tracheostomy.

Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of emerging atypical pneumonia. In patients with tracheostomy, coronavirus hypothetically coexists with well-known bacterial agents. A 61-year-old male patient with tracheostomy was admitted to the hospital with dyspnea, fever and increased tracheal secretions. Laboratory findings revealed lymphopenia and elevated C-reactive protein and procalcitonin levels. Chest computed tomography showed consolidation areas and ground-glass opacities more prominent in subpleural areas. Although; two consecutive RT-PCR analyses of combined nasopharengeal/oropharengeal swabs were found to be negative for SARS-CoV-2 RNA, positivity was reported for endotracheal aspirate (ETA) sample. Significant growth of Pseudomonas aeruginosa and Stenotrophomonas maltophilia was detected in the bacterial culture of ETA sample. In conclusion, clinical samples for SARS-CoV-2 should be obtained through the lower respiratory tract, if possible and if upper airway samples are negative. To the best our knowledge, our paper is the first report of the patient with tracheostomy who was treated successfully for COVID-19.

COVID-19 pneumonia and pneumothorax: case series.

Barotrauma is a commonly reported complication in critically ill patients with ARDS caused by different etiologies, it's rate is reported to be around %10. Pneumothorax/pneumomediastinum in COVID-19 patients seem to be more common and have different clinical characteristics. Here we report 9 patients who had pneumothorax and/or pneumomediastinum during their stay in the ICU. Patients who were admitted to ICU between March 2020 and December 2020, were reviewed for presence of pneumothorax, pneumomediastinum and subcutaneous emphysema during their ICU stay. Demographic characteristics, mechanical ventilation settings, documented ventilation parameters, outcomes were studied. A total of 161 patients were admitted to ICU during the study period, 96 were invasively ventilated. Nine patients had developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema during their admission. Five of them were men and median age was 66.6 years. All patients were intubated and mechanically ventilated. All patients were managed conservatively. One patient was discharged from ICU, the others were lost due to other complications related to COVID-19. Upon detection of pneumothorax and/or mediastinum all patients were managed conservatively by limiting their PEEP and maximum inspiratory pressures and were followed by daily chest X-rays (CXR) for detection of any progress. None of the patients showed increase in size of their pneumothorax and/or pneumomediastinum. Hemodynamically instability due to pneumothorax and/or pneumomediastinum was not observed in any of the patients. Tension pneumothorax was not observed in any of the patients. Most common reason for death was sepsis due to secondary bacterial infections. Acute deterioration with rapid oxygen desaturation or palpation of crepitation over thorax and neck in a COVID-19 patient should prompt a search for pneumothorax or pneumomediastinum. Conservative management may be an option as long as the patients are stable.